Private practice and billing
Fees and insurance at OrthoCenter Munich
OrthoCenter is a private medical practice. Medical services are generally billed according to the German medical fee schedule (GOÄ). Whether and to what extent an insurer reimburses the costs depends on your individual policy, any public-service medical aid entitlement and the particular service.
At a glance
What matters for this decision.
- GOÄ is the basis for medical billing
- The scope and complexity are assessed individually
- Reimbursement depends on your insurance policy
- Clarify the financial framework before substantial planned services
Decision guide
Four points to discuss before deciding.
Use these points to prepare the question you want a second opinion to clarify.
- 01
Starting point
GOÄ is the basis for medical billing
- 02
Available information
The scope and complexity are assessed individually
- 03
Options
Reimbursement depends on your insurance policy
- 04
Next step
Clarify the financial framework before substantial planned services
Before arranging care
Understand billing and reimbursement before your visit.
This information is for privately insured patients, people entitled to German public-service medical aid (Beihilfe), self-paying patients and those with statutory insurance who are considering private orthopedic care.
The invoice reflects services actually provided, the medical work involved and the GOÄ rules. A reliable final amount often cannot be quoted without knowing the details of the individual appointment.
Billing and reimbursement are separate processes. Even for medically appropriate treatment, an insurance policy may limit particular services, fee multipliers or procedures.
Before extensive investigations, special procedures, an expert report or planned surgery, discuss the likely scope and costs with the practice and the organization responsible for reimbursement. For planned, substantial or potentially incompletely reimbursed services, the estimate can be submitted to the insurer if necessary.
The basis of billing
How a private medical invoice is calculated.
Private medical services are billed according to the German medical fee schedule. The invoice lists each service with its fee code, service description, multiplier and amount.
Modern services that are not listed directly in the fee schedule may, subject to the GOÄ requirements, be billed by analogy with a service of equivalent nature, cost and time. The actual invoice depends on the services performed.
Private insurance and Beihilfe
Why an invoice and reimbursement are not the same.
Privately insured patients receive their medical invoice and submit it to their insurer and, where applicable, Beihilfe, depending on their policy, deductible and personal decision. Reimbursement is determined by the relevant contract and policy conditions, not by the practice’s website.
For an expensive planned procedure, a special treatment or an individual fee agreement, written clarification with the payer in advance is advisable. The practice cannot guarantee full reimbursement.
Self-paying patients
Private medical care without comprehensive private insurance.
Patients with statutory health insurance can also receive private treatment as self-paying patients. Before a service is provided, it should be clear that statutory insurance generally does not cover the costs, except where a specific arrangement has been agreed in advance.
The medically appropriate scope is determined by the question, existing findings and examination. This is why this page does not give flat final prices for investigations or treatment.
Planned services
When advance clarification is especially useful.
Discuss costs in advance for extensive investigations or follow-up measurements, gait and running analysis, PRP, hyaluronic acid, infusions or other special procedures.
Orthopedic expert reports and extensive records reviews, planned operations and potentially separate hospital services also warrant advance clarification. The same applies to services for which your policy provides limited reimbursement.
Before your appointment
Questions you can clarify in advance.
Which services are likely to be needed? Is there a medically reasonable alternative? Will analogous billing or a special agreement apply?
Should an insurer or other payer be contacted in advance? Will there be additional costs beyond the physician’s services, for example hospital charges?
Original information
Official billing and reimbursement resources.
Common questions
Answers to common questions.
How much does an initial appointment cost?
The amount depends on the consultation, examination, existing findings and any additional investigations. Billing follows the GOÄ for the services actually provided. The practice can explain the likely financial framework if you have questions.
Will my private health insurance cover all costs?
That depends on the individual policy, deductibles, fee multipliers and the particular service. Full reimbursement cannot be guaranteed. Check your policy before substantial planned services.
Can I make an appointment if I have statutory health insurance?
Yes, as a self-paying patient. Reimbursement by statutory health insurance must not be assumed and should be clarified in advance.
How are expert reports charged?
The scope depends on the question, examination, volume of records, imaging and the requested form of report. An initial review allows a clearer estimate of the work involved.
PD Dr med Daniel P. BertholdOrthopedic surgeon · University lecturer · Sports orthopedicsNext step
Which contact route fits your request?
Choose between a clinical appointment, second opinion, athlete care or a professional inquiry.
